NEUROPATHOLOGY OF ORTHOTOPIC LIVER-TRANSPLANTATION - AN AUTOPSY SERIES OF 16 PATIENTS

Objective.-To examine the neuropathologic findings seen in the setting of orthotopic liver transplantation (OLT) and to asses the role, if a ny, that the neuropathology had in the patient's death. Design.-Retros pective autopsy series of 16 patients. Setting.-Tertiary referral cent er with a high volume of liver transplantation.Patients.-Sixteen OLT p atients who died and in whom a complete autopsy, including examination of the brain and spinal cord, was performed. Results.-Sixteen patient s, including 13 women and 3 men, comprised the study group. Patients r anged in age from 25 to 64 years (mean 44.8 years). Postoperative OLT survival ranged from 1 to 1962 days (mean 236 days). Reasons for the i nitial OLT included hepatitis (n = 6), fulminant hepatic failure (n = 4), cryptogenic cirrhosis (n = 2), methotrexate toxicity (n = 1), post operative complication (n = 1), primary biliary cirrhosis (n = 1), and hepatocellular carcinoma (n = 1). Autopsies in 13 (81%) patients show ed neuropathology; in only 2 patients, however, was the primary cause of death attributable to these findings. The most common neuropatholog y was related to anoxia or infarction, specifically, ischemia or focal neuronal necrosis (n = 9), infarction (n = 4), and diffuse anoxic enc ephalopathy (n = 3). Other central nervous system findings included in fection with Aspergillus, Candida, and Toxoplasma (n = 3). The most co mmon cause of death was infection-related in 8 patients. One patient d ied of pulmonary hypertension, 1 of acute rejection, and 1 of possible hyperacute rejection. Two patients died directly as a consequence of neuropathology findings; one had massive central edema with herniation , and the other had a large intracerebral hemorrhage with herniation. The exact cause of death was unclear in 3 patients. Conclusions.-The m ost common neuropathology findings in this series were related to isch emia and infarction. Neuropathology findings are a significant cause o f morbidity, but were only rarely the main cause of death (n 2) in the OLT patients in this study.